I was getting my prescriptions filled yesterday- I had taken them to a new place because I found a $25 coupon if you brought in a new prescription. Once we got the insurance all sorted out (a lengthy process since all of the information isn't super obvious on the card), I went to pay for the pills, and the pharmacist asked me this:

"Does your insurance cover acupuncture? Because you'll probably be able to get off your meds if you try it."

Um, I don't remember asking you for your opinion. But nonetheless, this statement bugged me, and I couldn't quite place my finger on it. This morning, as I was making my coffee, it occurred to me: why do people assume that psych meds are somehow optional?

I guess you could say that insulin is "optional" for diabetics, or that rifampin and isoniazid are "optional" for people with tuberculosis. Let's not talk about chemo for cancer, either! Sheesh.

I understand that not everyone likes, or wants, to use psychotropic meds. And that's fine with me. However, I find them necessary. I've tried to stop taking them, and I end up a suicidal anxious mess, practically unable to leave my bed. I don't really like having to take meds. They're expensive, they do have side effects, it's a pain to remember to take them, and I really don't like needing them.

But I do.

I'm trying to tell myself that there is nothing wrong with psych meds. As much as I don't like having to take them, I'm eternally grateful that these meds exist. Waking up to an almost unthinkable sense of foreboding and dread is not the way I want to live. Although I rarely wake up happy and chipper (I'm NOT a morning person!), my meds let me face the day. To me, they are necessary, and likely always will be.

13 comments:

sannanina
said...

Hmm... Like you I self-identify as a skeptic and a rather scientifically minded person. Yet I see psychotropic medication very critcally, partially because of my own experiences, partially because of what I have read about it, and partially (there is just no denying it) because of growing up in a family (and compared with the US a culture) that is generally reluctant to take medication in the first place.I have tried several medications during my ongoing fight with depression - two SSRIs (first Celexa than Paxil which is supposedly very potent) and one noradrenaline reuptake inhibitor (reboxetine - it's not approved in the US as far as I know). I have been on each of these medications for about six months, increasing the dosage over time, yet I did not have any positive effect. (Well, reboxetine made me sleep less, which was in a way good, except that instead of 10 to 12 hours per day I slept only 4 and I got extremely anxious. Also, I still did not experience positive emotions and my depressive thoughts continued.) My one and only suicidal attempt actually happened while being on Paxil and having been on it for about two or three months - I don't think Paxil MADE me suicidal (although there are some reports that this happens to a small minority of people), I do think, however, that it did not help. In addition to that I experienced rather nasty withdrawal effects once I tapered off Paxil (according to my docotrs instructions).

All of this combined with that every single doctor that prescribed me an antidepressant wanted to keep me on that antidepressant even when it only caused side effects after two, three or even six months of taking it and that the pharma industry clearly lied about the frequency of serious withdrawal effects from SSRIs for years and only admitted that they occured rather frequently after a law suit forced them to has left me very reluctant to try out another antidepressant. Actually, when I finally came off of Paxil my psychiatrist wanted me to try amitryptiline, a tricyclic. As usual she did not mention the possible or even likely side effects (no doctor has ever made an effort to educate me about the side effects of antidepressants - I don't know if this is usual, or if I just seem to unitelligent to them to actually grasp that information). However, also as usual I looked up information about the medication myself. I was wondering how the hell she got the idea of recommending a drug that causes significant weight gain in many people to someone with binge eating disorder who is not only "obese" but has a hard time accepting her body in the first place. I refused to take it.

I don't write this to say psychotropic medication is always bad - there have been plenty of studies that showed it helps some people with depression (as does psychotherapy). And for diseases like bipolar disorder or schizophrenia it is pretty much the only valid treament option. What I would like to see, though, is that doctors, therapist and the general public wake up to the fact that there is not magic bullet when it comes to treating mental illness. Different people with a condition differ, and while we know some of the factors that can contribute, we don't know which factor plays what role in which individual. It is not even clear that everyone with depression has a lack or serotonine in certain brain circuits, and we don't yet have the ability to measure levels of neurotransmitters in a living brain. (I once had a psychiatrist tell me that depression is caused only by genetics in 100% of the cases, that environmental factors never play a role and that the only way to treat it is medication - this is just as wrong as saying that everyone can be successfully treated by psychotherapy.)

I really think there needs to be a less ideologically and more empirically driven approach to the treatment of mental illness. There also needs to be more and better patient education that really talks about all treament options that have been found to work in empirical studies - education that honestly talks about the pros and cons of every approach and that gives honest numbers of how many people profit, as well as information about the things we don't yet know about each treatment. Unfortunately I see very little of it - right now there seems to be a lot of agenda pushing instead.

All this said, I do agree that the pharmacist was completely out of line - and I am glad that medication works for you.

(PS: I am considering trying medication that influences Dopamine levels in the brain such as Wellbutrin since Dopamine is the only neurotransmitter that is known to play a role in depression which I have not tried to influence yet. However, I am not sure how the average doctor will react if I walk into his or her office telling them what class of drug I want.)

I think you raised some important points: skepticism about meds is a good thing, just as it is about any other treatment. I resisted for a while, but eventually I got to the point where I had run out of options. I can't function in therapy without them.

I guess my point is that having to rely on psych meds isn't any worse than having to rely on meds for any other condition. And it irks me that people always assume I'm eager to get off of them. I mean, in some sense, I am, but it's almost a subtle judgement from some (not you!) that I can't pull myself up by my bootstraps and just cope.

And I agree that the pharmaceutical will have a lot of answering to do someday with their so-called "research."

I hope you find something (whether medication or not) to help you cope. And, as always, I enjoy reading your comments. :)

You are right, psych meds are not inherently worse than other meds. The only thing that makes them problematic is that they usually have quite a number of undesirable and sometimes harmful side effects, in this they are just as but not more problematic than any other medication with the same problem.

Also, I am not good at saying things like that (it always comes out awkward). But I really appreciate that you engage in serious discussion with me, sometimes disagreeing, while at the same time telling me you enjoy my comments. One of my biggest problems is that I am terribly rejection sensitive - I am always afraid of saying something stupid, that people don't like me, that I should better shut up, etc (can't you tell I am social phobic?) This persists even in an anonymous or semi-anonymous online environment. And this is exactly why I appreciate the way you make me feel welcome so much.

I definitely identify with your experience. I resisted taking psych meds and have tried to go of multiple times since, but the reality is, I just can function without them. I become incapable of rational thought and devoid of any ambition whatsoever. I still haven't resigned myself to the fact I'll be on them for the rest of my life, but for now, this is my reality.

Skepticism is also a good thing when it comes to so-called 'alternative' treatments. Given that mental illness can be life threatening I'm not too impressed with the pharmacist's off handed recommendation. "You'll probably be able to get off your meds..." Did he consult his crystal ball for that information?

"It is time for the scientific community to stop giving alternative medicine a free ride.There cannot be two kinds of medicine: medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments." Angell & Kassirer NEJM, 1998.

My dad is a psychiatrist. He's a very good one (at least according to the Royal Institute of Psychiatrists here in the UK) and I remember a comment he made to me once. He said that if a drug works in 90% of cases, psychiatrists shouldn't prescribe it and just assume it will work. They shouldn't blindly follow the standard practice. There's nothing wrong with giving a drug that works in only 4% of cases, so long as the patient in question is one of that 4%. The problem is that a lot of doctors (not just psychiatrists) will prescribe the drug that's listed in the text books as working most of the time.

It sounds to me that sannanina's problems come partially from psychiatrists doing just that - assuming that his patients would all be average and react in the standard way.

Not explaining things properly to the patient is something my sister complains about. She's recently qualified as a doctor and moans about various hospital staff doing things without taking the time to tell the patient what they were doing and why.

I know a friend who wasn't warned about side effects. A friend of mine was prescribed a really strong antidepressant and then wasn't warned that it was addictive. Guess what, she kept taking more and more. Needless to say, she didn't go back to that doctor again!

I'm a skeptic about alternative medicine and think that the pharmacist was way out of line. If you've found medication that works for you, then you shouldn't be forced to exchange it for something which doesn't work.

IMHO, that pharmacist was COMPLETELY out of line. And if it were me, I'd be writing his supervisor a formal complaint (but that's just my personal MO). That's just not cool. His job is not to express opinions about your meds. It's simply to give them to you. In my mind, his statement is almost as inappropriate as asking someone picking up AZT how they contracted AIDS. Some things you just don't say.

On the topic of "alternative" medicine, I think you know that I'm largely a believer. But I like an "integrated" approach. If I have a sinus infection, then I need an antibiotic. Period. If I have asthma issues, then I need my inhaler. But if a supplement like phosphatidyl serine is going to be the most effective thing for bringing down my cortisol levels, then bring it on!

I grew up in a family of chiropractors... and I currently see mine, plus an acupuncturist and a craniosacral therapist on a regular basis. And it works for me. (And I gave a little frown to the recent acupuncture coverage that came out, and stomped off with a bit of a "hmmmph".) And while I'm happy to go on and on about it all and how it's all worked for me, I also know that it's not for everyone.

That said, I also know that without my psych meds, I am a fucking mess. And I will likely be on psych meds for the rest of my life. And that's just the way it is. Acupuncture may help my anxiety symptoms, but it's in my genes, and that just can't be gotten rid of.

I'm fortunate to have found providers who agree with my integrated approach to my health. I left a recent acupuncture session with a promise to call my shrink about upping my meds (which I did -- both call and up the dose)... as well as tiny seeds taped in my ears to help my anxiety. And I really believe that both helped. But seriously... don't try and take away my antidepressants. No one would be happy. No one.

Libby - I think the division of medicine into mainstream, supposedly scientifically based, and alternative is somewhat artificial in the first place. The important thing is if something has been shown to work in well-designed studies that included a control group. And while this might be more often true for the methods used in "mainstream' medicine it is not always true.

Also, in my experience the medicine practiced by mainstream doctors often doesn't take side effects fully into account. Psych meds obviously have often quite strong side effects, but I think in this case their use is still worthwhile for many patients because they experience a net gain by using them. But this is not necessarily true for all other treatments/ medications. For example, I have had atopic excema for pretty much all my life - and at times it got really bad. The standard mainstream treament for this was at the time (and still is to a large degree) corticosteroid ointment applied to the affected areas. The treament works - coricosteroids are after all very powerful substances. The problem is, however, that coricosteroids have quite severe long-term side effects, even when applied to the skin. The main problem is that the skin gets thinner over time through treament. Still, it took a homeopath to suggest a treament (another ointment) that was effective almost without side effects.

I am very critical of homeopathy. I don't actually know any studies about it's effectiveness, but to my mind the theory behind it seems quite questionable. I also probably wouldn't go to see a homeopath myself (at the time my mum took me - I was still a teenager). However, I talked about this one treament with a mainstream dermatologist and he confirmed that it had been shown to be effective. Yet most doctors that I know still continue to go the coricosteroid route first. In addition, at least in Germany public health insurance only pays for coricosteroids. This is not scientifically based practice of medicine, and it needs to change.

That said, I believe that people need to be warned about "alternative" methods that have been tested for their effectivness and have shown absolutely no effect in several studies. Also, there needs to be better education that "alternative" does not necessarily mean less harmful in terms of side effects. For example, it does not matter if a substance comes from a plant or if it was synthesized in a lab. Actually, many main stream medications, even substances used in chemotherapy, were originally isolated from plants.

In my fantasy, this is how things would go if I was in your situation--

Pharmacist: Does your insurance cover acupuncture? Because you'll probably be able to get off your meds if you try it.

Katy: Does your insurance cover broken noses? Because you're going to get one if you don't ring up my drugs and shut up.

Seriously though, I'm so sick of BS like that. I'm sick of the attitude that psych meds are optional. Yeah, my meds are optional--sort of like getting out of bed in the morning, showering, eating and being able to leave the house are optional. If I don't want to do any of that, I don't have to take my meds! Of course, if I was a stronger person I'd be able to push myself to do all those things sans drugs. (Says my wise shrink, "Katy, people who aren't depressed don't have to TRY HARDER to SHOWER. Showering is not HARD.") Imagine this pharmacist saying this to someone picking up an inhaler, or insulin, or, hell, even freaking contacts! It'd be seen as incredibly unethical and ridiculous and inappropriate--and it should be the same for psych meds. GRR.

I've been on and off psychotropic meds in my life--on, right now. I too dislike having to take them, but have made a choice to be able to function in the world. I am also very interested in alternative medicine. I love the fact, for instance, that so many studies are being done now on the effects of meditation. I've found it quite helpful in many ways. But I don't think of it as a substitute for the meds.

Someday I hope to be off the meds again. But if that doesn't happen, my quality of life is a hell of a lot better with them than without them.

One of my daughters has been on them for 4 years now. Every time we try her off them she becomes depressed, anxious, fearful, withdrawn . . . much like I was as a child. Thank god we've got them for her so she doesn't have to grow up like me.

Yikes! While I've personally found acupuncture to be helpful in regularizing my menstrual cycle so I could get pregnant (there's research to suggest it aids the circulation to the reproductive organs), it certainly isn't a pharmacist's place to be offering advice to a patient. It's your own business what treatments you use.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.